Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario

Sunday, December 2, 2012

Adderall, a Drug of Increased Focus for N.F.L. Players - NYTimes.com

The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht.

" 'You've got to get some of these,' " Becht recalled the player saying. "I was like, 'What the heck is that?' He definitely needed it. He said it just locks you in, hones you in. He said, 'When I have to take them, my focus is just raised up to another level.' "

Becht said he did not give Adderall another thought until 2009, when he was playing in Arizona and his fellow tight end Ben Patrick was suspended for testing positive for amphetamines. The drug he took, Patrick said, was Adderall. Becht asked Patrick why he took it, and Patrick told Becht, and reporters, that he had needed to stay awake for a long drive.

Those two conversations gave Becht, now a free agent, an early glimpse at a problem that is confounding the N.F.L. this season. Players are taking Adderall, a medication widely prescribed to treatattention deficit hyperactivity disorder, whether they need it or not, and are failing drug tests because of it. And that is almost certainly contributing to a most-troubling result: a record-setting year for N.F.L. drug suspensions.

According to N.F.L. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall. That is a 75 percent increase over the 12 suspensions announced in 2011 and, with a month to go in 2012, it is the most in a year since suspensions for performance-enhancing drugs began in 1989.

At least seven of the players suspended this year have been linked in news media reports to Adderall or have publicly blamed the drug, which acts as a strong stimulant in those without A.D.H.D. The most recent examples were Tampa Bay cornerback Eric Wright and New England defensive lineman Jermaine Cunningham last week.

The N.F.L. is forbidden under the terms of the drug-testing agreement with the players union from announcing what substance players have tested positive for — the urine test does not distinguish among types of amphetamines — and there is some suspicion that at least a few players may claim they took Adderall instead of admitting to steroid use, which carries a far greater stigma. But Adolpho Birch, who oversees drug testing as the N.F.L.'s senior vice president for law and labor, said last week that failed tests for amphetamines were up this year, although he did not provide any specifics. The increase in Adderall use probably accounts for a large part of the overall increase in failed tests.

"If nothing else it probably reflects an uptick in the use of amphetamine and amphetamine-related substances throughout society," Birch said. "It's not a secret that it's a societal trend, and I think we're starting to see some of the effects of that trend throughout our league."

Amphetamines have long been used by athletes to provide a boost — think of the stories of "greenies" in baseball clubhouses decades ago. That Adderall use and abuse has made its way to the N.F.L. surprises few, because A.D.H.D. diagnoses and the use of medication to control it have sharply increased in recent years.

According to Dr. Lenard Adler, who runs the adult A.D.H.D. program at New York University Langone Medical Center, 4.4 percent of adults in the general population have the disorder, of which an estimated two-thirds are men. Birch said the number of exemptions the N.F.L. has granted for players who need treatment for A.D.H.D. is "almost certainly fewer" than 4.4 percent of those in the league.

The rates of those with the disorder fall as people get older; it is far more prevalent in children and adolescents. A report from the Centers for Disease Control and Prevention, using input from parents, found that as of 2007, about 9.5 percent or 5.4 million children from ages 4 to 17 had A.D.H.D. at some point. That was an increase of 22 percent from 2003. Boys (13.2 percent) were more likely to have the disorder than girls (5.6 percent).

Of children who currently have A.D.H.D., 66.3 percent are receiving medication, with boys 2.8 times more likely to receive medication. Those 11 to 17 years old are more likely to receive medication than younger children.

But Adderall, categorized by the Drug Enforcement Administration as a Schedule II controlled substance because it is particularly addictive, is also used by college students and even some high school students to provide extra energy and concentration for studying or as a party drug to ward off fatigue.

Dr. Leah Lagos, a New York sports psychologist who has worked with college and professional athletes, said she had seen patients who have used Adderall. She said she believed the rise in its use by professional athletes mimicked the use by college students. Just a few years ago, she said, it was estimated that 1 in 10 college students was abusing stimulants like Adderall and Ritalin. That estimate, Lagos said, has almost doubled.

"It's certainly a performance-enhancing drug," Lagos said. "College kids call it the Superman drug. Take someone who is tired after a long practice, give them a stimulant. It amps up their mood and energy. It really enhances their focus, and for football players, that's crucial.

"Athletes are often taking it to fight fatigue and exhaustion. It's almost like taking 100 cups of coffee. They can take it during training camp when their bodies are especially fatigued, and the other is right before a game, to boost them. Those are two patterns that are being reported most frequently. But there is the party scene, too, and that's happening on a larger level."

The long-term effects of taking Adderall are not well understood, doctors said. While doctors prefer Adderall with a sustained release to treat adults with A.D.H.D. — so that it calms them throughout the day — Adler said that data on students who were misusing diverted medication indicated they were often using a shorter-acting version of Adderall with effects that lasted just three to five hours.

"It may not get you through a game," Adler said.

Even if it does, the players union has tried to warn its members that substances like Adderall are banned unless a player receives a therapeutic-use exemption from the league. That process includes a review of an A.D.H.D. diagnosis by an independent administrator and other specialists.

There is a poster in each locker room about banned substances, and the union sent out a memo in October that emphasized that prescription drugs like Adderall are prohibited. Birch said efforts to make players aware of banned substances had been ample, though the league wishes the union would allow it to reveal what players test positive for. Officials think that it would be a deterrent and that hearing what others are caught for reminded players of what substances were banned.

George Atallah, a union spokesman, said he expected the number of positive tests to drop because of the greater attention being paid to Adderall. Players who have recently been suspended were tested earlier in the year, before Adderall became a topic of conversation throughout the league.

"It's a reflection that the system we have in place works," Atallah said. "Given the amount of suspensions we've seen this year, we have made a greater emphasis on making players aware of the policy on this particular substance."

Will Hill, though, said he did not think the N.F.L.'s Adderall problem would go away anytime soon. Hill, a safety for the Giants, served a suspension this season for Adderall use. Hill began using Adderall for A.D.H.D. in the spring and he said he did not realize it was on the league's banned list until he had already started taking it without getting the required waiver.

Hill said that beginning in high school, he needed extra tutors because of his limited attention span. He added that he could not stay still until he began taking Adderall. With Adderall, he is calm and able to focus on his tasks, on and off the field. On Thursday, Hill said he knew many people in and out of football who needed Adderall to function properly.

Hill was suspended in October; he has since watched one player after another blame Adderall for his positive test. He guessed that among players who use Adderall, "it's 50-50" whether they need it for A.D.H.D. or are using it because it is a powerful stimulant.

Hill said that he was troubled that there were players without the disorder who take Adderall for the jolt of energy and the extreme focus it provides, and by the idea that some players may be blaming the drug when they are instead taking steroids.

"It foggies everything up," Hill said. "This person can say it's Adderall, and how do we decipher the fakers from not? When you try to get an advantage over the next person, that's why we get into these situations we're in."